Comparison of Cerebral Angiography and Transcranial Doppler Sonography in Acute Stroke

We compared digital intra-arterial angiography and transcranial Doppler sonography in acute cerebral ischemia as part of a wider study on a continuous series of 48 patients with acute focal cerebral ischemia in the carotid territory, observed within 4 hours of the onset of symptoms. The most significant Doppler findings of the middle cerebral artery included no detection of the artery when occlusion of the carotid siphon or the middle cerebral artery at its origin was shown by angiography and reduced flow velocities and asymmetry (symptomatic < asymptomatic) when the occlusion was located in the terminal tract of the middle cerebral artery mainstem or in numerous terminal branches. Higher flow velocities in the anterior cerebral artery or posterior cerebral artery, mostly in the symptomatic hemisphere, often accompanied middle cerebral artery pathology, probably indicating collateral compensatory pathways. (Stroke 1989;20:899-903) The high frequency of acute intracranial occlu-sion and the therapeutic use of active throm-bolytic agents stress the need to monitor the patency of intracranial cerebral arteries in acute ischemic strokes.1 Noninvasive exams should rep-resent the first choice in detecting the occurrence o